Annelotte van Bommel

61 Variation in immediate breast reconstruction INTRODUCTION Breast cancer is themost frequently diagnosed cancer inwomen in theNetherlands. Curative surgical treatment for breast cancer consists of breast conserving therapy or mastectomy. Mastectomy is performed in approximately 40% of patients with invasive breast cancer 1,2 and in 33% of patients with ductal carcinoma in situ (DCIS). 3 To restore the breast contour following mastectomy, a breast reconstruction can be performed. Breast reconstruction during initial breast cancer surgery is known as immediate breast reconstruction (IBR); delayed breast reconstruction is reconstruction at a later time. 4 Reasons to offer patients IBR are of both esthetic and psychosocial nature. IBR generally leads to higher patient satisfaction, improved body image, and increased self-esteem compared to delayed reconstruction. 5 Therefore, guidelines suggest considering IBR in all patients who undergo mastectomy. 6,7 However, the percentage of patients actually undergoing IBR or delayed reconstruction after mastectomy is generally low and varies significantly from 5% to 30% in population-based studies. 8 Several factors such as patient factors, tumor-related factors, hospital factors, and demographic factors may contribute to the final decision to perform IBR. 8 Current practice patterns of postmastectomy IBR in the Netherlands are unknown. Evaluating hospital performances using case-mix-adjusted data can identify true variation between hospitals and ultimately help to reduce undesirable variation in clinical practice and improve the quality of care for breast cancer patients. Therefore, the present study aimed to investigate the variation in the use of IBR after mastectomy for invasive breast cancer and DCIS between all hospitals in the Netherlands and identify whether the variation could be attributed to patient and tumor factors influencing the use of IBR. 4